Screening for hemostasis during hemorrhagic emergencies.

We propose a laboratory screening scheme for the hemostatic system to be adopted during hemorrhagic emergencies in hospital patients bleeding excessively to the extent of requiring massive blood transfusions. The aim of the screening scheme is to establish whether excessive bleeding is due to alterations of the hemostatic system or to other causes. Seven tests were chosen on the basis of their simplicity, rapidity and comprehensiveness in the evaluation of the hemostatic system: the platelet count, the prothrombin and activated partial thromboplastin times, the thrombin and reptilase times and the assays of plasma fibrinogen and fibrin(ogen) degradation products. We then attempted to validate the choice of these tests with 172 emergency cases due to excessive bleeding which led to massive blood replacement. The high frequency of abnormalities of one or more tests found in this series (93%) indicates the excellent diagnostic sensitivity of the screening scheme in detecting hemostatic abnormalities. The screening scheme was also useful in the diagnostic work-up of the bleeding disorders most frequently encountered during hemorrhagic emergencies (disseminated intravascular coagulation, liver disease, unsuspected heparinization and the hemostatic defect associated with massive blood transfusion).